A patient with kidney failure is prescribed a medication that is primarily excreted through the kidneys. Which of the following statements is most accurate regarding the pharmacokinetics of this medication?
Hepatic metabolism will fully compensate for the decreased renal excretion
Dose adjustment may be necessary to prevent drug accumulation
The medication's half-life will likely be shorter due to decreased renal function
The risk of drug toxicity is decreased due to impaired excretion
The Correct Answer is B
A. Hepatic metabolism will fully compensate for the decreased renal excretion: This is inaccurate. While the liver may play a role in metabolizing some drugs, it cannot fully compensate for reduced renal clearance of medications that are primarily excreted by the kidneys.
B. Dose adjustment may be necessary to prevent drug accumulation: In patients with kidney failure, reduced renal clearance slows the elimination of renally-excreted drugs. Without dose adjustment, drug levels can build up, increasing the risk of toxicity. Dosing must be tailored to the patient’s renal function, often guided by creatinine clearance or GFR.
C. The medication's half-life will likely be shorter due to decreased renal function: The opposite is true. Impaired renal function slows drug excretion, prolonging the drug’s half-life, which means the drug stays in the system longer and can accumulate to toxic levels if not adjusted.
D. The risk of drug toxicity is decreased due to impaired excretion: Impaired excretion increases, not decreases, the risk of toxicity. Renally-excreted drugs that are not properly cleared can accumulate and reach dangerous concentrations in the bloodstream.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. "Limit your fluid intake to meal times.": Fluid restriction is not a standard recommendation for patients taking Verapamil unless they have another condition like heart failure. Adequate hydration is important, especially to counter constipation, a known side effect of the drug.
B. "You can expect swelling of the ankles while taking this medication.": While peripheral edema is a known side effect of Verapamil, it is not something patients should expect or accept without reporting. Significant swelling may require dose adjustment or switching medications.
C. "This medication will not affect your heart rate": Verapamil is a calcium channel blocker that slows AV node conduction and reduces heart rate. It is used for conditions like hypertension, angina, and arrhythmias, and can cause bradycardia, especially in high doses.
D. "Increase your daily intake of dietary fiber.": Verapamil frequently causes constipation by decreasing gastrointestinal motility. Increasing dietary fiber, fluid intake, and physical activity are recommended to minimize this side effect and promote regular bowel movements.
Correct Answer is C
Explanation
A. Advise the patient to continue using the nasal decongestant but reduce the frequency to once daily: Continued use, even at a reduced frequency, may not resolve the underlying issue. Prolonged use of topical nasal decongestants can lead to rebound congestion (rhinitis medicamentosa), which won't improve without discontinuation.
B. Suggest increasing the dosage of the current nasal decongestant to manage congestion: Increasing the dosage worsens rebound congestion and the dependence cycle. Higher doses can also raise the risk of systemic side effects such as elevated blood pressure or tachycardia.
C. Educate the patient on discontinuing the nasal decongestant and recommend a saline nasal spray for symptom relief: This is the most appropriate intervention. Rebound congestion is best managed by stopping the decongestant. Saline sprays help moisturize nasal passages and reduce symptoms safely during withdrawal.
D. Prescribe a stronger nasal decongestant to alleviate symptoms more effectively: A stronger formulation would likely exacerbate the problem. The key to managing rhinitis medicamentosa is breaking the cycle of decongestant overuse, not intensifying it.
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